Combat Casualty Care Statistics as Outcome Measures for Medical Treatment on the Battlefield: A Review and Reconsideration of the Data

Abstract

This review focuses on the use of the case fatality rate (CFR), the killed in action percentage (%KIA) and died of wounds (%DOW) as battlefield medical outcome measures and reports the current statistical data for recent conflicts. Further, the review defines each statistic, and identifies their usefulness and limitations in medical research. The CFR, %KIA, and %DOW have been used by many authors since the beginning of the conflicts in Afghanistan and Iraq in 2001. However, these statistics are primarily derived from administrative databases maintained by the Defense Casualty Analysis System, and their primary purpose is not to evaluate the effectiveness of medical treatment. We believe both the magnitude of the improvements in CFR and %KIA and impact of medical treatment on these statistics have been in some cases overstated. Battlefield lethality is significantly impacted by non-medical factors. Some medical researchers, likely unknowingly, continue to use these statistics, especially the CFR, without taking all battlefield confounders into account. The Department of Defense Trauma Registry provides opportunity for improved data collection, performance improvement, and standardization of the combat casualty care statistics thereby allowing for meaningful comparisons and a better understanding of battlefield trauma care.